title: Point-of-care testing for Hb A1c in the management of diabetes: a systematic review and metaanalysis.
abstract: BACKGROUND
  The measurement of hemoglobin A(1c) (Hb A(1c)) is employed in monitoring of patients with diabetes. Use of point-of-care testing (POCT) for Hb A(1c) results at the time of the patient consultation potentially provides an opportunity for greater interaction between patient and caregiver, and more effective care.
  
  
  OBJECTIVE
  To perform a systematic review of current trials to determine whether POCT for Hb A(1c), compared with conventional laboratory testing, improves outcomes for patients with diabetes.
  
  
  METHODS
  Searches were undertaken on 4 electronic databases and bibliographies from, and hand searches of, relevant journal papers. Only randomized controlled trials were included. The primary outcome measures were change in Hb A(1c) and treatment intensification. Metaanalyses were performed on the data obtained.
  
  
  RESULTS
  Seven trials were found. There was a nonsignificant reduction of 0.09% (95% CI -0.21 to 0.02) in the Hb A(1c) in the POCT compared to the standard group. Although data were collected on the change in proportion of patients reaching a target Hb A(1c) of <7.0%, treatment intensification and heterogeneity in the populations studied and how measures were reported precluded pooling of data and metaanalysis. Positive patient satisfaction was also reported in the studies, as well as limited assessments of costs.
  
  
  CONCLUSIONS
  There is an absence of evidence in clinical trial data to date for the effectiveness of POCT for Hb A(1c) in the management of diabetes. In future studies attention to trial design is needed to ensure appropriate selection and stratification of patients, collection of outcome measures, and action taken upon Hb A(1c) results when produced.
authors.affiliation: Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Lalansary@ksu.edu.sa
authors.forename: Lubna
authors.initials: L
authors.lastname: Al-Ansary
authors.forename: Andrew
authors.initials: A
authors.lastname: Farmer
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hirst
authors.forename: Nia
authors.initials: N
authors.lastname: Roberts
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
authors.forename: Rafael
authors.initials: R
authors.lastname: Perera
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Price
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D017060:Patient Satisfaction; D019095:Point-of-Care Systems
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin